Dissapointed with plucking and acell any advice going forward !

[HairRobinHood]

@topcat - Same thoughts here. Couldn't agree more.

[RichardDawkins]

Ok topcat good point.

So why am i against FUT and highly invasive operations. I had a bad operation in the past where my leg was involved in an accident and therefore i have a gigantic scar from the underside till over my knee. This scar cannot be repaired cause the tissue is thick and hard.

Thats why iam absolutely against flap reduction and FUT and also why iam personally afraid of operations. If they would have taken my leg more seriously then today i wouldnt have a nice leg which really looks bad.

For this reason Acell i am really setting my hopes to this. And also ejj has a chance to revision his scar, i know its additional trauma but there is also a chance by using Acell and plucked hairs to get this fixed.

And therefore i quote ejj here, i would only go for FUE these days but insist of using Acell and small test sides with plucked hairs.

You know its maybe in my world simple but, my scar at my leg cant be fixed in life time. But even if you have scars at your head, at least we can give it a shot with plucked hairs and Acell.

The more it is used the more we can se the "magic" behind it or grasp it.

And which doc is offering him the free revision? Dr Cooley or the greece one. Thats the question.

Oh and before it comes down to this, scars today have even this stigmata around it. Believe me, when you went to a smim class with my leg you know exactly what to expect.

@topcat : Is this what HairRobinHood is doing right now, Confidence or not? I think to insult other people has nothing to do with confidence

[topcat]

Richard you make a good point. Would anyone here return to a back surgeon that left him partially paralyzed, or a brain surgeon that left him blind for more work to try and correct the situation? I would hardly believe it, but somehow HT is different and many seem to be okay with it. Chances are they would research who they thought the best in the world was in this area and would go to them sparing no expense.

I think that scar is too large and although revision might reduce it somewhat it probably not worth any unintended consequences. FUE into the area if donor is available might be a better option. If this option is taken I suggest a small session at first.

Dr. Cooley at the very least should offer him a partial refund and let him decide what he thinks it best for himself.

I like to post what I think is a logical answer to the situation but in the end it’s up to the patient. I also know some forums and posters don’t like to hear logical answers one of the reasons I was banned from HTN and why the site in my view has so little credibility. This is the problem with this industry, people think they have to lie, cheat and steal to make a buck. You can do the right thing and still do very well.

[RichardDawkins]

@topcat : Your points are valid. I gave the advise for the free revision to use it because i never had the chance to with my knee and also because there is a chance for Acell to work.

But of course he had to speak to Dr Cooley at first. The good thing is, that his beard donor area didnt get damaged during this process.

With the small session i absolutely agree. The problem in his case is, that the greece clinic had done a bad job.

As i said i only said i was pro revision because of the higher chances here to get this done. But yes Dr Cooley should give him a refund and let him deceide whats best.

But in ejj´s situation i can understand why he asks for an advise here. I would do the same to hear different opinions with their pros and cons.

The reason why people still get back to their ht docs is the believing " This time he will get it right"

[topcat]

Richard, we agree, if I lost one eye in an operation I want to be given enough respect to choose a different doctor to work on the other eye. I don't want to be forced to go back to the original doctor because of financial considerations. I expect the doctor to have the common decency to mitigate my expenses.

The only way I believe a revision might work is to do what Balloonman did if anyone here remembers him from about 8-9 years ago. But inserting a balloon under the skin is a long and painful process which can also have servere consequences if anything goes wrong.

[RichardDawkins]

Iam familiar with tissue expansin but not with Balloonmans case because i wasnt around here at this time.

So the common sense here, before we all give away advises here, that ejj should talk with Dr Cooley.

I think he should do this as soon as possible to get this nightmare fixed finally

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[Jerry Cooley, MD]

Dr Cooley's response

This posting leaves out some important information. I was consulted by this patient to 1) improve the old donor scars from numerous procedures and 2) add hair to the front which was very thin despite all the work he’d had done. It was my understanding that these were equally important. I suggested FUT to fill in the front and described the new plucking procedure. Because it was so new and we did not have a clear idea of the success rate, there was no charge for the plucked grafts or use of ACell. The only fee was for 2,000 FUT grafts. This was not planned as a ‘one and done’ and there was discussion that multiple procedures would be necessary to fully correct his old donor scarring. No results were promised or guaranteed but I certainly did give him an optimistic assessment based on the early results I was seeing in other patients.

Looking at the results:

1) Plucked beard grafts in old donor scars: The patient’s scalp had extensive wide donor scarring from old procedures. We performed about 600 plucked beard grafts throughout this area. I have not seen the patient in person but from the photographs it appears that virtually none of them grew. We have since learned that plucked grafts do not grow well in scars and that the wider and denser the scar tissue, the lower the success. I understand the disappointment and upset by the patient as I too am extremely disappointed by the failure of the plucked grafts to grow in scar tissue. Looking at the photographs, there appears to be an improvement in the texture of the old scars from the multiple recipient sites made and implantation of ACell coated grafts. I believe this will make the area even more receptive to FUE grafts in the future (see below).
2) New donor scars: The patient had minimal donor reserves and minimal scalp laxity. Yet he desperately needed some density in the front central region of his scalp. Despite all the work he’d had done, there was a lack of density which was the primary factor contributing to his balding look. I identified 3 areas which I thought we could harvest from. We were able to obtain over 2,000 FUs which we used to transplant the frontal core. Because all the good, safe areas of his donor area had already been harvested, I had to go to areas that I would normally avoid. I wrongly assumed that ACell would ensure scarless healing of these donor strip sites. Two of the three sites stretched due to their location and are now creating a cosmetic problem. I have since learned that ACell doesn’t prevent donor scars, but it does eliminate the thick, dense scar tissue that would normally result. These did not stretch because of ACell. The texture of these new “hairless gaps” is softer and feels like normal skin, according to the patient. I believe that these areas will be very receptive to FUE grafts. I take full responsibility for creating this result and have offered to fix it (see below).
3) FUT results: It seems unfair to judge this case without looking at the results of the grafting to the frontal scalp. The patient had already been committed to longer hair to cover all his old donor scars, yet this made the lack of hair in his frontal scalp even more apparent. From what I understand, the 2,000 FUs have grown in well, yet no before and afters are presented. Also, on top of everything, the patient had an unfortunate incident in the post op healing phase where a relative accidentally slammed the car trunk down on his grafted area, creating a full thickness laceration. I have offered to fix this as well. It’s easy to second guess in retrospect and question whether the patient should have had strip FUT. Yet, he desperately needed more hair in the front and it seemed like the best option at the time.

Moving forward:

1) I believe that a combination of beard and scalp FUE will correct the two donor ‘scars’ I created. Another option is re-excision but there are no guarantees the results will be better.
2) Beard and scalp FUE will be even more effective in the old donor scars as a result of the area being ‘rejuvenated’ by wounding and ACell.
3) Plucked grafting should work well in his frontal scalp and to fix the area where he had the accident and to add some more density overall.

I have been in communication with the patient for two months now and have repeatedly offered all this at no charge. I sincerely hope the patient takes me up on it. I am as anxious as he is to see this turn out well.

Dr Cooley

[Bakez]

Would it be that when you pluck the hairs, perhaps you are just 'reactivating' the stem cells, in line with the recent research by Cotsarelis, and that is why plucked hairs won't grow in scars.. because there isnt anything there.

So I don't think the plucked hair is growing a 'new' follicle at all.

[Jerry Cooley, MD]

Would it be that when you pluck the hairs, perhaps you are just 'reactivating' the stem cells, in line with the recent research by Cotsarelis, and that is why plucked hairs won't grow in scars.. because there isnt anything there.

So I don't think the plucked hair is growing a 'new' follicle at all.

Perhaps. What I think is happening is that native stem cells from surrounding follicles contribute to the rebuilding of a new follicle around the plucked graft. But these are just theories and require more study.

[Spanish Dude]

Okay, I have read Dr. Cooley's answer, and it looks to me like a well balanced one.

I agree with Cooley that repairing the "soft scars" using Acell again, will probably result again in the same "wide soft scars". The scalp is very tight.

Just a guess: Wound closure with Acell produces soft tissue, and this soft tissue, under tightness, will probably expand more than regular scar tissue (which is stronger). So, maybe, a standard closure without Acell, would result in a strong standard scar that would not expand.
Anyway, I think it is better not to take risks, and keep the "soft scars" as they are, i.e, not repair them again.

Cooley is offering a free FUE to cover the donor "soft-scars". I think this is a reasonable offer.
But given that the patient has little donor left, I would first do a "safety test fue" to see if the FUE grafts take well in these "soft scars".

Even better, I would re-try autoplucking on these "soft scars", but this time, using scalp hair, not beard hair. Autoplucking is safe, even if it fails, becasue it doesn't deplete the donor.


@ejj:
So you have had in total 8 strips? 5 previous ones, plus 3 new ones (Cooley's)? Thats a lot, and probably explains why the new wounds widened so much (although Acell could also be at fault for the excessive expansion).

Regarding the bald area that received the 600 autoplucked beard hairs, ejj says that this area is not a scar, but just a "shock loss area" resulting from a previous procedure in Greece. But Cooley says that this area was scar tissue and this explains why the beard plucked hairs didn't take. There is a contradiction here, but I am sure it will be solved.

ejj, I am interested to know about the new soft tissue produced by Acell. Is it pigmented, or not? does it "tan" when exposed to the sun light? Or does it remain distinctively whiter than the rest of the scalp?

thanks ejj and Dr. Cooley for sharing this interesting information, of a real case.

[ejj]

Spanish Dude ,

re the pigment , its pinker slightly, than surrounding scalp, will have to let you know if it tans or not, as Im from the UK, and we only have 2 seasons over here ......`winter ` and `june `!!!

thanks

ej

[Spanish Dude]

ah, ok, lol, we here do have a longer summer and scar tissue sucks because it remains white and stands out from the rest.
I had a small 3mm wart removed from my waist using elecricity, and now I have a 5mm white spot and its relatively noticeable when I tan in the summer.
Curiously the white spot is not hard, but soft, even though no Acell was used.

You say that your Acell "soft scars" are slightly pinkish, but this pinkness could be transient. Tell me in about 1 year.

cheers

Spanish Dude ,

re the pigment , its pinker slightly, than surrounding scalp, will have to let you know if it tans or not as Im from the the UK and and we only have 2 seasons over here ......`winter ` and `june `!!!

thanks

ej

[HairRobinHood]

Autoplucking is safe, even if it fails, becasue it doesn't deplete the donor.

Yea, that is nice.

[topcat]

Dr. Cooley, was the patient given the impression that Acell prevented donor scars? Was he advised that this was just an assumption and as of yet had not been proven?

The reason I ask is that it’s probably the most important point. If someone is made fully aware that these are unknowns and decides to move forward than they would need to assume part of the risk. Otherwise I would imagine that the clinic should accept that responsibility and all that comes with it.